Surgical Resection of Secondary Chest Wall Tumors

Abstract

Objective: The objective of this study was to evaluate which factors influence survival following surgical resection of secondary tumors of the chest wall (non-bronchial carcinoma). Methods: Between 1990 and 2001, 69 patients (23 men, 46 women) underwent chest wall resection with curative intent. All of the patients were retrospectively analyzed for sex and age, presenting symptoms, tumor location, disease-free interval, histology, radiation therapy or chemotherapy, surgical techniques and extent of resection, 30-day mortality and long-term survival. Results: The most common tumors were isolated locally recurrent breast cancer (n = 33) and renal cell carcinoma (n = 17). Resection of chest wall tumors in all of the other patients revealed a kaleidoscope of different pathologies (n = 19). Overall 5-year survival was 38 %. In patients with isolated recurrence of breast cancer and in patients with chest wall metastases of renal cell cancer, the median survival was 40.6 months and 53.7 months, respectively. A disease-free interval of more than 24 months and no systemic chemotherapy after mastectomy were parameters for a favorable prognosis in patients with breast cancer. Conclusions: We conclude that chest wall resection of secondary chest wall tumors is a safe and effective treatment as part of a multidisciplinary approach. The role of surgery will continue to evolve as improvements in systemic treatment occur.

Chest wall tumor - recurrent breast cancer - metastases - surgery

References

• 1 Kaplan E LMP. Non-parametric estimation from incomplete observations.  J Am Stat Assoc. 1958;  53 457-481
• 2 Peto R PJ. Asymptomatically efficient rank invariant test procedures.  J R Stat Soc A. 1972;  135 185-206
• 3 Incarbone M, Pastorino U. Surgical treatment of chest wall tumors.  World J Surg. 2001;  25 218-230
• 4 King R M, Pairolero P C, Trastek V F, Piehler J M, Payne W S, Bernatz P E. Primary chest wall tumors: factors affecting survival.  Ann Thorac Surg. 1986;  41 597-601
• 5 Burt M. Primary malignant tumors of the chest wall. The Memorial Sloan-Kettering Cancer Center experience.  Chest Surg Clin N Am. 1994;  4 137-154
• 6 Arnold P G, Pairolero P C. Chest-wall reconstruction: an account of 500 consecutive patients.  Plast Reconstr Surg. 1996;  98 804-810
• 7 McCormack P, Bains M S, Beattie Jr E J, Martini N. New trends in skeletal reconstruction after resection of chest wall tumors.  Ann Thorac Surg. 1981;  31 45-52
• 8 Graeber G M, Snyder R J, Fleming A W. et al . Initial and long-term results in the management of primary chest wall neoplasms.  Ann Thorac Surg. 1982;  34 664-673
• 9 Fisher B, Anderson S, Redmond C K, Wolmark N, Wickerham D L, Cronin W M. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer.  N Engl J Med. 1995;  333 1456-1461
• 10 Neff P T, Bear H D, Pierce C V. et al . Long-term results of breast conservation therapy for breast cancer.  Ann Surg. 1996;  223 709-716 716-717 (discussion)
• 11 Faneyte I F, Rutgers E J, Zoetmulder F A. Chest wall resection in the treatment of locally recurrent breast carcinoma: indications and outcome for 44 patients.  Cancer. 1997;  80 886-891
• 12 Downey R J, Rusch V, Hsu F I. et al . Chest wall resection for locally recurrent breast cancer: is it worthwhile?.  J Thorac Cardiovasc Surg. 2000;  119 420-428
• 13 Hathaway C L, Rand R P, Moe R, Marchioro T. Salvage surgery for locally advanced and locally recurrent breast cancer.  Arch Surg. 1994;  129 582-587
• 14 McKenna Jr R J, McMurtrey M J, Larson D L, Mountain C F. A perspective on chest wall resection in patients with breast cancer.  Ann Thorac Surg. 1984;  38 482-487
• 15 Stadler W M, Kuzel T, Dumas M, Vogelzang N J. Multicenter phase II trial of interleukin-2, interferon-alpha, and 13-cis-retinoic acid in patients with metastatic renal-cell carcinoma.  J Clin Oncol. 1998;  16 1820-1825
• 16 Giuliani L, Giberti C, Martorana G, Rovida S. Radical extensive surgery for renal cell carcinoma: long-term results and prognostic factors.  J Urol. 1990;  143 468-473 473-474 (discussion)
• 17 Dekernion J B, Ramming K P, Smith R B. The natural history of metastatic renal cell carcinoma: a computer analysis.  J Urol. 1978;  120 148-152
• 18 Riches E WGI, Thackray A C. New growths of the kidney and ureter.  Br J Urol. 1951;  23 297-356
• 19 Cerfolio R J, Allen M S, Deschamps C. et al . Pulmonary resection of metastatic renal cell carcinoma.  Ann Thorac Surg. 1994;  57 339-344
• 20 Pfannschmidt J, Hoffmann H, Muley T, Krysa S, Trainer C, Dienemann H. Prognostic factors for survival after pulmonary resection of metastatic renal cell carcinoma.  Ann Thorac Surg. 2002;  74 1653-1657